1.12 Do people feel that accepting gifts influences prescribing?

Most (56%) of the psychiatry trainees surveyed by Hodges felt that accepting gifts did not influence their prescribing4. In the Aldir et al. study6 few doctors thought that a gift of a textbook influenced prescribing habits (less than 6%). Similarly, they felt that lunches or dinners provided by the industry had little influence on them, although they did feel that free samples affected their prescribing. In Barnes and Holcenberg’s study, 60% of medical students and 75% of pharmacy students felt that promotional practices influenced prescribing7. Patients surveyed by Blake and Early8 also felt that gifts from the pharmaceutical industry to doctors were likely to influence prescribing (6% said it never did, 18% said rarely, 43% sometimes, and 16% frequently). They were more likely to disapprove of gifts (except free samples) if they felt that they influenced prescribing and increased cost. One limitation of this study was that many patients were unaware that such gifts were given, so had little time to consider their opinion of them while completing the questionnaire.

Eighteen per cent of the Turkish doctors in Güldal and Semin’s study27 felt that gifts strongly affected prescribing, 12% felt they had a medium effect, 44% low, and 27% felt that they had no effect on prescribing.

Madhaven et al.9, found that physicians were more likely to think that other doctors' prescribing was influenced by gifts, than that their own was. They also found doctors with more patients were less likely to agree that most doctors are influenced by gifts and less likely to think it is inappropriate to accept gifts. Banks and Mainous38 surveyed medical school faculty at the University of Kentucky, USA. Of a list of gifts given by sales representatives, none were seen as influencing prescribing by more than half of the respondents, although personal relationships with sales representatives were seen as influencing prescribing by 66% of faculty. PhD staff were more likely than MD staff to think that gifts influenced prescribing, and to oppose the acceptance of gifts. Most internal medicine faculty and residents surveyed by McKinney et al.16 felt that doctors could be compromised by accepting gifts (67% and 77%). However some (23% of faculty members and 15% of residents) believed that doctors could not be compromised regardless of the value of the gift received. In Cockerill and Williams’24 survey of Ontario pharmacists, 50% felt there was a conflict of interest in accepting benefits from the drug industry. Those licensed after 1980 were less likely to think so.

CONCLUSION: In most studies most doctors denied that they were influenced by gifts. The available data suggest that doctors may be more willing to say that other doctors are influenced than they are themselves but this hypothesis merits more research. The only study on patients’ attitudes found they were more likely to disapprove of gifts (except free samples) if they felt that they influenced prescribing.